What is it? The Medicare prescription drug benefit, also called "Medicare Part D," is a new prescription drug coverage program available to anyone enrolled in Medicare.
What does it cost? For most patients, the cost of the Medicare drug benefit includes monthly premiums, copayments ("coinsurance"), and an annual deductible. Unlike standard Medicare, private insurance companies administer the Medicare drug benefit, so costs vary by company, plan, and state. Some people can qualify for low-income assistance based on their income and assets.
Which drugs are covered? Each plan has its own list of covered drugs, called a formulary. Not every drug is available on every plan, and their prices vary plan by plan.
Do patients save money on Medicare Part D? Some people save money, but some do not. It depends on the plan that is chosen and how much is spent on prescription drugs.
Which patients should sign up for Medicare prescription drug coverage? To answer this question, patients will need to think carefully about how much they spend on prescription drugs and how much they think they might spend in the future. PACE enrollees can keep their current PACE benefits. They can sign up for Part D later without penalty because PACE is considered creditable coverage.
What if a patient already has prescription drug coverage? There are several options. Patients can choose one of the following:
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Keep the current plan and do not participate in Medicare Part D. Patients can enroll later without penalty if they provide proof of "creditable coverage" (a plan equal to or better than Medicare Part D). PACE and PACENET are creditable coverage.
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Keep the current plan and add Medicare Part D for additional coverage.
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Drop the current plan and replace it with Medicare Part D.
In some cases, patients may lose employer-sponsored coverage benefits for drugs and physician or hospital charges if they enroll in Medicare Part D, so they should check with their current plan administrators before making any changes.
Which plan should a patient choose? Because there are many Medicare Part D plans and all are administered by private insurance companies, each differs in which drugs are covered, how much it costs, and where drugs can be purchased. These companies may change their benefits or may stop offering Medicare drug coverage in the future. Patients should compare multiple plans to see how well they meet their own specific needs in terms of the drugs on a plan's approved list, and which pharmacies participate.
For more information about prescription drug coverage, contact:
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